Geauga Sports Medicine

Primary specialty

Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X

Legal business name

GEAUGA SPORTS MEDICINE

Practice address

11800 E Washington St
Auburn, OH 44023

Phone

(440) 285-6452

NPI assigned

Dec 8, 2006

Last updated

Jan 13, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Kellis, DONPI 1831190313

Title

President

Phone

(440) 285-1796

Specialties & licenses 2

Addresses

Tax ID family

Geauga Sports Medicine2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Geauga Sports Medicine, LLC

  • Sports Medicine (Preventive Medicine) Physician
  • Chardon, OH
  • NPI 1396746970
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael J Kellis, D.O.

  • Sports Medicine (Internal Medicine) Physician
  • Chardon, OH
  • NPI 1831190313
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231804800000",
    "number": "1699834390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11800 E WASHINGTON ST",
            "city": "AUBURN",
            "state": "OH",
            "postal_code": "44023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 E WASHINGTON ST",
            "city": "AUBURN",
            "state": "OH",
            "postal_code": "44023",
            "telephone_number": "440-285-6452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEAUGA SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2009-01-13",
        "status": "A",
        "authorized_official_last_name": "KELLIS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "440-285-1796",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.